She refuses to accept me as her husband before bedtime . She gets angry with me sleeping in our bed. looks for me screaming 'where's my husband'. Threatens me with her first and keeps me from going to sleep.

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Deeshusband, I am so sorry that you and your wife are going through this.

Dementia causes a number of serious changes to the brain that can result in very difficult behavioral issues and delusions. Although you mention Sundowner’s Syndrome, I think that another, called Capgras Syndrome, is at play here. This particular delusion arises due to the dementia patient’s cognitive inability to correctly identify other people. In this case, your wife’s brain is incapable of accurate facial recognition, therefore she believes you are not her husband. Misidentification can cause the patient a great deal of confusion and agitation, and they may come to the most rational conclusion they are capable of: that their spouse or child has been replaced by an “imposter.”

While there is no treatment for Capgras, there are some techniques that you can use to help reorient your wife and soften the delusions she may be experiencing. You can find a few of them in this article:
Capgras Syndrome: How to Cope with a Loved One's Delusions

Returning to the idea of Sundowner’s Syndrome, it sounds like you are on the right track if her delusional behavior is escalating later in the day. If this behavior is more consistent, then it may simply indicate that her condition is progressing. Either way, I would speak with her physician about the possibility of making some changes to her medications. Some drugs can help to reduce anxiety and fear that result from increased confusion and disorientation. This might be able to give you both some peace and quality rest at night.

Additionally, countless members have come up with creative, drug-free methods for keeping their loved ones calm during episodes of sundowning. You can find some of their tips here:
How to Cope with Sundowning: Tips from Family Caregivers

I’m sure some other members will come along with more suggestions. I hope this information helps you and you wife. Remember that adequate sleep is extremely important for both of you.

Best of luck to you, Deeshusband. Hang in there.
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Call her doctor. She needs meds to calm her. Also, is this new? She might have a urinary tract infection.

This must be so very hard and heartbreaking. I'm sorry.
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